CDC Immunization Related Requirements Test Plan (CNI) v5

This test plan is to be used for the testing of the CDC EHR Immunization Related Requirements developed under Contract-No: 200-2014-60994 . All test cases are required to be executed. The test plan includes both functional and interoperability tests including Vaccine Update Notifications (HL7 V2.5.1 VXU/Z22) and Query and Response (Evaluated History and Forecast Group Z44/Z42).
This version is updated for use in the 2016/2017 test cycle. It adds support for alignment with ONC 2015 Certification Criteria. .

1. Initial Data Load

The initial Data load will consist of the vendor entering data during live interactive testing for 4 patients with various scenarios. The data entry will include demographic data, Immunization histories and specific conditions for each patient.

1.1. Juana Mariana Vazquez Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 6-year old Juana Mariana Vazquez. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Vazquez. The data includes immunizations provided by the practice.

The vendor also enters:

�� Two vaccines administered at other sites

o an influenza vaccine given at a local pharmacy

o an inactivated polio vaccine given elsewhere and not reported to the registry - the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

�� Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

NOTE: the historical vaccines will be imported during the Registry query (e.g. from another practice)


Comments
Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

Pre Condition
No PreCondition

Post Condition
The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juana Mariana Vazquez using the test data provided.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patients active allergies.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Vazquez, 6-year old

Juana Mariana Vazquez is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Vazquez.


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre Condition

No PreCondition


Post Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez.


Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as "Medicaid Number") Vendor supplied Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name Shoreline Pediatrics Y
Patient ID: Type (e.g., medical record number, IIS ID) Vendor supplied Y
Patient Name: First Juana Y
Patient Name: Middle Mariana Y
Patient Name: Last Vazquez Y
Patient Date of Birth 11/01/2011 Y
Birth Time 11:05 N
Patient Gender (Administrative Sex) F Y
Patient Multiple Birth Indicator No Y
Patient Birth Order NA C
Responsible Person Name: First Joanna Y
Responsible Person Name: Middle Merida Y
Responsible Person Name: Last Vazquez Y
Responsible Person Name: Relationship to Patient Grandmother Y
Mother's Name: First Maria Y
Mother's Name: Middle Merida Y
Mother's Name: Last Vazquez Y
Mother's Name: Maiden Last Acosta Y
Patient Address: Street 4345 Standish Way Y
Patient Address: City Stamford Y
Patient Address: State CT Y
Patient Address: Country USA Y
Patient Address: Zipcode 06903 Y
Patient Address: County of Residence Fairfield N
Race White Y
Ethnicity Hispanic or Latino Y
Birthing Facility Name (Birth Delivery Location Address BDL) Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901		 [Y - birthing facility name, not address]
Patient Birth State CT Y
Patient Primary Language English Y
Patient Telephone Number (203) 555-1212 Y
Patient Telephone Number Type (e.g., home, cell) home Y
Patient E-mail Address jmg@gmail.com N
Publicity Code Reminder/recall - any method (02 HL70215)
 Y
Protection Indicator N Y
Protection Indicator Effective Date NA N
Immunization Registry Status NA N
Preferred Contact Method Phone Y

Notes for Testers

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EMR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.


1.1.2. Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from practice

Patient History from the local practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Vazquez. This included an MMR dose that was given too early. This MMR doses serve to seed checking for dose given too early in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Query the Registry for Juana Mariana Vazquez, TestStep: Mark first MMR Dose as Invalid.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez.


Post Condition

The immunization history the known to the local practice is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - DTaP

Entered BY

Sandra Molina

Y

Ordering Provider

J. Rodriguez

Y

Entering Organization

Shoreline Pediatrics

Y

Vaccine Event information source (Administration Notes)

Historical information - from parent's written record (NIP001 03)

Y

Value/Text for Vaccine Type

DTaP

Y

Date/Time of Start of Administration

11/20/2015

Y

Vaccine Administered

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

Y

Administered Amount (of Vaccine)

0.5

Y

Administered Units (of Measure)

mL

Y

Administering Provider

Linda Casera

Y

Administered-at Location

4253 Standish Way, Stamford Connecticut 06903

Y

Lot Number

D643QS8243

Y

Substance Expiration Date

12/1/2015

Y

Substance Manufacturer Name

Sanofi Pasteur Inc (MVX PMC)

Y

Completion Status

CP

Y

Route of Administration

Intramuscular (NCIT C28161)

Y

Administration Site

Left Deltoid (HL70163 LD)

Y



Historical Vaccine from Another Practice - Polio

Entered BY

Sandra Molina

Y

Ordering Provider

J. Rodriguez

Y

Entering Organization

Shoreline Pediatrics

Y

Vaccine Event information source (Administration Notes)

Historical information - from parent's written record (NIP001 03)

Y

Value/Text for Vaccine Type

poliovirus vaccine, inactivated (CVX 10)

Y

Date/Time of Start of Administration

2/21/2013

Y

Vaccine Administered

poliovirus vaccine, inactivated (CVX 10)

Y

Administered Amount (of Vaccine)

0.5

Y

Administered Units (of Measure)

mL

Y

Administering Provider

Linda Casera

Y

Administered-at Location

4253 Standish Way, Stamford Connecticut 06903

Y

Lot Number

D335PV9644

Y

Substance Expiration Date

4/22/2013

Y

Substance Manufacturer Name

Sanofi Pasteur Inc (MVX PMC)

Y

Completion Status

CP

Y

Route of Administration

Intramuscular (NCIT C28161)

Y

Administration Site

Left Deltoid (HL70163 LD)

Y

Reaction

VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS

Y






































































































Notes for Testers

The MMR doses serve to seed checking for dose given too early in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Query the Registry for Juana Mariana Vazquez, TestStep: Mark first MMR Dose as Invalid.


1.1.3. Enter Initial Immunization Data for Juana Mariana Vazquez from Another Practice

Patient History from another practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Vazquez.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez.


Post Condition

The immunization history from another practice is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - DTaP

Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source (Administration Notes) Historical information - from parent's written record (NIP001 03) Y
Value/Text for Vaccine Type DTaP Y
Date/Time of Start of Administration 11/20/2014 Y
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) (NDC 49281-0286-01) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D643QS8243 Y
Substance Expiration Date 12/1/2015 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT C28161) Y
Administration Site Left Deltoid (HL70163 LD) Y



Historical Vaccine from Another Practice - Polio

Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent's written record (NIP001 03) Y
Value/Text for Vaccine Type
poliovirus vaccine, inactivated (CVX 10)
Y
Date/Time of Start of Administration 2/21/2013 Y
Vaccine Administered poliovirus vaccine, inactivated (CVX 10) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D335PV9644 Y
Substance Expiration Date 2/22/2013 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Subcutaneous (NCIT C28399) Y
Administration Site Left Deltoid (HL70163 LD) Y
Reaction Adverse Reaction of (VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS Y

Notes for Testers

No Note


1.1.4. Enter Initial Immunization Data for Juana Mariana Vazquez Reported by Parent

Patient History from a pharmacy as reported by the parent is entered into the EMR.

Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Vazquez.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post Condition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent

Entered BY Sandra Molina Y
Ordering Provider Gina Ricci Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source (Administration Notes) Historical information - from other provider (NIP001 02) Y
Value/Text for Vaccine Type Influenza vaccine Y
Date/Time of Start of Administration 10/15/2015 Y
Vaccine Administered influenza, seasonal, injectable, preservative Free (CVX 140) Fluvirin (NDC 66521-0118-02)) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Gina Ricci Y
Administered-at Location Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901 Y
Lot Number 8L4B3423 Y
Substance Expiration Date 12/03/2015 Y
Substance Manufacturer Name Novartis (MVX NOV) Y
Completion Status CP Y
Route of Administration IM (NCIT C28161) Y
Administration Site
Y

Notes for Testers

No Note


1.1.5. Enter Adverse Reaction to the Polio Vaccine

The EHR captures structured data regarding adverse events as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez.


Post Condition

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Vazquez.


Test Objectives

Supporting data for:

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

Adverse Reaction Substance/Agent inactivated polio vaccine (e.g. Poliomyelitis vaccine adverse reaction (disorder) 293117006) Y
Reaction febrile seizure (e.g. Simple febrile seizure (finding) 432354000)
VXC11^convulsions (fits, seizures) within 72 hours of dose^		 Y
Date (of the reaction) 2/21/2012 Y

Notes for Testers

No Note


1.2. Juan Marcel Marina Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 1 1/2-year old Juan Marcel Marina. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juan Marcel Marina. The data includes a clinical history of congenital asplenia.


Comments
Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

Pre Condition
No PreCondition

Post Condition
The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juan Marcel Marina using the test data provided.

Test Objectives
Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Supporting data for:

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Marina

Juan Marcel Marina is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juan Marcel Marina.


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre Condition

No PreCondition


Post Condition

The EMR has recorded all of the pediatric demographic in the record created for Juan Marcel Marina.


Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as "Medicaid Number")

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Juan

Y

Patient Name: Middle

Marcel

Y

Patient Name: Last

Marina

Y

Patient Date of Birth

03/04/2015

Y

Birth Time

11am

N

Patient Gender (Administrative Sex)

M

Y

Patient Multiple Birth Indicator

No

Y

Patient Birth Order

NA

C

Responsible Person Name: First

Manuel

Y

Responsible Person Name: Middle

Marcel

Y

Responsible Person Name: Last

Marina

Y

Responsible Person Name: Relationship to Patient

Father

Y

Mother's Name: First

Anita

Y

Mother's Name: Middle

Francesca

Y

Mother's Name: Last

Marina

Y

Mother's Name: Maiden Last

Morales

Y

Patient Address: Street

4623 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901

[Y - birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1213

Y

Patient Telephone Number Type (e.g., home, cell)

Home

Y

Patient E-mail Address

None

N

Publicity Code

 Reminder/recall - no calls (03 HL70215)

Y

Protection Indicator

 No

Y

Protection Indicator Effective Date

N

Immunization Registry Status

N

Preferred Contact Method

Phone

 Y

Notes for Testers

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EMR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.


1.2.2. Enter Clinical History for Juan Marcel Marina

The EHR captures structured data regarding a problem of congenital asplenia as part of the clinical history.

Test Story

Description

The clinical history of Moderate Persistent congenital asplenia is documented in the record created for Juan Marcel Marina.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juan Marcel Marina.


Post Condition

The clinical history of the congenital asplenia is documented in the record created for Juan Marcel Marina.


Test Objectives

Supporting data for:

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

In this case, the vaccine is recommended due to the presence of a specific condition (congenital asplenia), testing contraindications.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical history data provided with all required attributes indicated by [Y]:

Adverse History of Congenital Asplenia (reason for administering Meningococcal vaccine to a child)


Problems Congenital absence of spleen (disrder) SNOMED-CT 493030006); Asplenia (congenital) - (ICD-10-CM Q89.1)
Coded Value expected using SNOMED-CT or ICD-10-CM
 Y Coded value expected using SNOMED-CT or ICD

Notes for Testers

No Note


1.3. Juana Mariela Gonzales Morales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Mariela Gonzales Morales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for twin Mariela Gonzales Morales.


Comments
Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

Pre Condition
No PreCondition

Post Condition
The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Mariela Gonzales Morales using the test data provided.

Test Objectives
Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

1.3.1. Enter Initial Demographic Data for Juana Mariela Gonzales Morales

Juana Mariela Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Mariela Gonzales Morales.


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre Condition

No PreCondition


Post Condition

The EMR has recorded all of the pediatric demographic in the record created for Mariela Gonzales Morales.


Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as "Medicaid Number")

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Juana

Y

Patient Name: Middle

Mariela

Y

Patient Name: Last

Gonzales

Y

Patient Date of Birth

10/01/2016

Y

Birth Time

11am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

1

C

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Morales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother's Name: First

Joanna

Y

Mother's Name: Middle

Elena

Y

Mother's Name: Last

Gonzales

Y

Mother's Name: Maiden Last

Morales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y - birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

 Reminder/recall - no calls (03 HL70215)

Y

Protection Indicator

 N

N

Protection Indicator Effective Date

 NA

N

Immunization Registry Status

 NA

N

Preferred Contact Method

Text

 Y

Notes for Testers

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EMR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.


1.4. Juana Maria Gonzales Morales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Maria Gonzales Morales. There are no transactions associated with this test case.

Test Story

Description
The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for twin Juana Maria Gonzales Morales.

Comments
Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

Pre Condition
No PreCondition

Post Condition
The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juana Maria Gonzales Morales using the test data provided.

Test Objectives
Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales Morales

Juana Maria Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Maria Gonzales Morales.


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre Condition

No PreCondition


Post Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Maria Gonzales Morales.


Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as "Medicaid Number")

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Juana

Y

Patient Name: Middle

Maria

Y

Patient Name: Last

Gonzales Morales

Y

Patient Date of Birth

10/01/2016

Y

Birth Time

11:15am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

2

Y

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Gonzales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother's Name: First

Joanna

Y

Mother's Name: Middle

Elena

Y

Mother's Name: Last

Gonzales

Y

Mother's Name: Maiden Last

Morales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y - birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

Reminder/recall - no calls (03 HL70215)

Y

Protection Indicator

 Yes

Y

Protection Indicator Effective Date

 10/1/2016

Y

Immunization Registry Status

N

Preferred Contact Method

Text

 Y

Notes for Testers

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EMR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.


2. Juana Mariana Vazquez Visit

Juana Mariana Vazquez visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The parents refuse the Polio vaccine due to prior issues. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

2.1. Query the Registry for Juana Mariana Vazquez

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Vazquez. The Z42 response is used to display, reconcile, and update the immunization information in the EMR.

Test Story

Description
The EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Vazquez.
Querying the registry will consist of the vendor creating Z44 messages for Juana Mariana Vazquez to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.

Comments
No Comments

Pre Condition
Juana Mariana Vazquez is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Vazquez Initial Data Load'

Post Condition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool.

Test Objectives
Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

2.1.1. Select Patient Juana Mariana Vazquez

Select patient Juana Mariana Vazquez, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juana Mariana Vazquez is selected as the patient and her record is opened in the EMR.


Comments

No Comments


Pre Condition

Juana Mariana Vazquez Initial Data Load completed.


Post Condition

Juana Mariana Vazquez is the active working patient in the EMR.


Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Vazquez from similar sounding names using all of the pediatric demographics:

  • Patient ID (previously listed as "Medicaid Number") - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana
  • Patient Name: Middle - Mariana
  • Patient Date of Birth - 11/01/2011
  • Birth Time - 11:05
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - No
  • Patient Birth Order - NA
  • Responsible Person Name: First - Joanna
  • Responsible Person Name: Middle - Merida
  • Responsible Person Name: Last - Vazquez
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent)
  • Mother's Name: First - Maria
  • Mother's Name: Middle -Merida
  • Mother's Name: Last - Vazquez
  • Mother's Name: Maiden Last - Acosta
  • Patient Address: Street - 4345 Standish Way
  • Patient Address: City - Stamford
  • Patient Address: State - CT
  • Patient Address: Country - US
  • Patient Address: Zipcode - 06903
  • Patient Address: County of Residence - Fairfield
  • Race - White
  • Ethnicity - Hispanic or Latino
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901
  • Patient Birth State - CT
  • Patient Primary Language - English
  • Patient Telephone Number - (203) 555-1212
  • Patient Telephone Number Type (e.g., home, cell) - home
  • Patient E-mail Address - jmg@gmail.com
  • Publicity - CodeReminder/recall - any method (02 HL70215)
  • Protection Indicator
  • Protection Indicator Effective Date
  • Immunization Registry Status
  • Preferred Contact Method - Phone

Notes for Testers

No Note


2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Vazquez

The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre Condition

Juana Mariana Vazquez Initial Data Load is completed.

Juana Mariana Vazquez is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.
Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20161015001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111011105 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551212 Value-Test Case Fixed
QPD-10 Multiple birth indicator N Value-Test Case Fixed
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juana Mariana Vazquez
Mother's Maiden Name Acosta
ID Number 123456
Date/Time of Birth 11/01/2011 11:05
Sex Female
Patient Address 4345 Standish Way Stamford CT 06903
Patient Phone (203)555-1212
Birth Indicator No
Birth Order

2.1.3. View and Compare response to request for vaccination history for Juana Mariana Vazquez

The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and compare to those in the EMR.

Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Vazquez). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

The physician accesses the record for Juana Mariana Vazquez and:
��� Reconciles the EHR vaccine history with the history retrieved from the registry:
o Accepts new vaccines from the registry data
o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is "invalid" as it was given too early (as notified by the registry)
o Retains the local history for influenza and polio vaccines that are not included in the registry report.

Comments

No Comments


Pre Condition

Juana Mariana Vazquez Initial Data Load is completed.

Juana Mariana Vazquez is the active working patient in the EMR.

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Vazquez)


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Evaluation Criteria

1. The EMR is able to receive the response from the Immunization Registry.

2. The EMR displays the information returned from the Immunization Registry according to the Juror Document.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20161015001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariana Vazquez
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2011
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2011
Date/Time Administration-End 11/01/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2011
Date/Time Administration-End 12/20/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2012
Date/Time Administration-End 05/20/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2013
Date/Time Administration-End 02/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2012
Date/Time Administration-End 11/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2013
Date/Time Administration-End 01/11/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2012
Date/Time Administration-End 09/25/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/29/2012
Date/Time Administration-End 10/29/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2013
Date/Time Administration-End 10/02/2013
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 11/04/2014
Date/Time Administration-End 11/04/2014
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2012
Date/Time Administration-End 11/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2013
Date/Time Administration-End 05/23/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2012
Date/Time Administration-End 08/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2015
Date/Time Administration-End 11/22/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2013
Date/Time Administration-End 12/15/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2012
Earliest Date to Give 04/29/2012
Latest Date to Give
Date When Vaccine Overdue 04/30/2013
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2016
Earliest Date to Give 09/01/2016
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason

2.1.4. Mark first MMR Dose as Invalid

Identify the first MMR dose which is given too early, as invalid. If the EHR does not already flagged the first MMR as invalid, the provider updates the first MMR to indicate it is ?invalid? as it was given too early (as notified by the registry).

In the Initial Data Load Step 2, MMR dose at 14 days prior to the current date is entered. As the first MMR was invalid, this should be listed as the first dose.

Test Story

Description

If the EHR does not already flag the first MMR as invalid, the provider updates the first MMR to indicate it is "invalid" as it was given too early (as notified by the registry)


Comments

If the EMR already recognizes the dose as invalid, then this step may be skipped.


Pre Condition

Initial Data Load -

Step 2: Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from practice


Post Condition

MMR status for the first MMR dose is set to invalid.


Test Objectives

dose validity is an important aspect of:

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria
Evaluation Criteria: The vendor is able to record that the first MMR vaccination dose is invalid with a reason that it was given too early, and therefore the dose administered on 11/22/2012 should indicated dose '1', and the dose administered two weeks prior to the current visit should indicate dose '2'.




















































Notes for Testers

No Note


2.1.5. View the vaccination forecast for Juana Mariana Vazquez

Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).

Test Story

Description

The physician accesses the record for Juana Mariana Vazquez and:

��� Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them)


Comments

No Comments


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Vazquez)


Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20161015001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariana Vazquez
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2011
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2011
Date/Time Administration-End 11/01/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2011
Date/Time Administration-End 12/20/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2012
Date/Time Administration-End 05/20/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2013
Date/Time Administration-End 02/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2012
Date/Time Administration-End 11/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2013
Date/Time Administration-End 01/11/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2012
Date/Time Administration-End 09/25/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/29/2012
Date/Time Administration-End 10/29/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2013
Date/Time Administration-End 10/02/2013
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 11/04/2014
Date/Time Administration-End 11/04/2014
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2012
Date/Time Administration-End 11/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2013
Date/Time Administration-End 05/23/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2012
Date/Time Administration-End 08/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2015
Date/Time Administration-End 11/22/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2013
Date/Time Administration-End 12/15/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2012
Earliest Date to Give 04/29/2012
Latest Date to Give
Date When Vaccine Overdue 04/30/2013
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2016
Earliest Date to Give 09/01/2016
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason

2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Vazquez

The Provider uses the EMR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system, and reconcile (import/update) records.

Test Story

Description

Juana Mariana Vazquez immunization registry provided Evaluated History and Forecast is reconciled with the Immunization history information in the EMR.


Comments

No Comments


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Vazquez)


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 12/20/2011
--VERIFY that this hepatitis B dose is invalid
measles, mumps, and rubella virus vaccine (CVX 30) administered 8/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 2/21/2013 [known only to EMR, not available from IIS]
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/15/2015 [known only to EMR, not available from IIS]

b. Vaccinations Imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 11/01/2011
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 05/20/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2012,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2013
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/21/2012
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/11/2013
rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2012
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/29/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2013
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2014
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2013
measles, mumps, rubella virus vaccine (CVX 94) administered 11/22/2015
Varicella virus vaccine (CVX 21) administered 12/15/2013

Notes for Testers

No Note


2.1.7. View the updated vaccination forecast for Juana Mariana Vazquez

Using the reconciled vaccine history information, the EMR displays the current Immunization Forecast to the user for Juana Mariana Vazquez.

Test Story

Description

Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated.


Comments

No Comments


Pre Condition

EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Vazquez').


Post Condition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.


Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 4/30/2012
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 10/31/2015
MMR due on 10/31/2015
Varicella due on 10/31/2015
influenza, unspecified formulation due on 09/01/2016

Notes for Testers

No Note


2.2. Juana Mariana Vazquez, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.

Comments
No Comments

Pre Condition
Juana Mariana Vazquez is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Vazquez Initial Data Load'

Post Condition
Visit orders are entered in Juana Mariana Vazquez' record.

Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's active allergies.

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

2.2.1. Order IPV and view prior reaction

The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

The physician accesses the record for Juana Mariana Vazquez and:

��� Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.


Post Condition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).


Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type IPV (CVX 10)
Date/Time Vaccine Refusal was recorded Current Date
Alert Alerts user to information about the prior febrile seizure post-IPV vaccine

Notes for Testers

No Note


2.2.2. IPV Parental Refusal

Documents mother?s refusal for IPV vaccine indicating the parent decision, the reason and documents a deferral.

Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother's refusal for IPV vaccine indicating the parent decision, the reason and documents a deferral.


Comments

No Comments


Pre Condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.


Post Condition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is recorded.


Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.


Evaluation Criteria

EMR documents the non-administration of the IPV due to the parental refulsal:

Substance/Treatment Refusal Reason Parental decision (NIP002 00)
Completion Status RE
Date/Time Vaccine Deferral was recorded Current Date
Deferral Reason Parental decision (NIP002 00)
Deferral Status Deferred

Notes for Testers

No Note


2.2.3. Enter Immunization Data for MMR Given 2 Weeks Prior

Patient History from the parent for the latest MMR vaccine that was given 2 weeks prior to the current visit? is entered into the EMR. This is a pre-condition to the attempt to enter the varicella vaccine order.

Test Story

Description

The EHR vendor loads immunization history data for an MMR dose entered 2 weeks prior to the current visit date and an MMR dose that was given too early. These MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose.


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez. All test steps that are part of the Query the Registry for Juana Mariana test steps are completed, including the vaccination forecasting.


Post Condition

The immunization history of the MMR that was administered 2 weeks prior to the test date is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Vaccine from Practice MMR II

Entered BY

Sandra Molina

Y

Ordering Provider

Frank Smith

Y

Entering Organization

Shoreline Pediatrics

Y

Administration Notes (Vaccine Event information source)

Historical information -- from parent's written record (NIP001 03)

Y

Date/Time of Start of Administration

14 days prior to the Current Date

Y

Vaccine Administered

MMR (CVX 03, NDC 0006-4681-00 - MMR II)

Y

Administered Amount (of Vaccine)

0.5

Y

Administered Units (of Measure)

mL

Y

Administering Provider

Sandra Molina

Y

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Y

Lot Number

0934GG

Y

Substance Expiration Date

10/31/2017

Y

Substance Manufacturer.

Merck Sharp & Dohme Corp (MVX MSD)

Y

Completion Status

CP

Y

Route of Administration

Subcutaneous (NCIT C28399)

Y

Administration Site

Left Deltoid

Y
















































































































Notes for Testers

The MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose.


2.2.4. Attempt to order Varicella Dose

No Description

Test Story

Description
The provider attempts to give a Varicella dose, and is warned that it is too soon to give a live vaccine dose.

Comments
No Comments

Pre Condition
Initial data load completed with demographic data, vaccination history, and clinical history. MMR dose entered at 14 days prior to the current date in TestCaseGroup: Initial Data Load, TestCase: Juana Mariana Vazquez Initial Data Load, TestStep: Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from practice.

Post Condition
The provider has been issued a warning that it is too soon to give another live virus dose.

Test Objectives
Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Evaluation Criteria
There should be a warning that the attempt to give a new Varicella Dose is too early - should get warning that 28 days must pass between 2 live virus vaccines if not administered at the same time due to the prior MMR vaccination 14 days earlier.

Notes for Testers
No Note

2.2.5. Records Influenza Vaccine administration route with data validation checking

The provider records the vaccine administration in the EMR and is prevented from incorrectly documenting vaccine route.

Test Story

Description

The nurse documents administration route for the IM inactivated influenza vaccine as 'intranasal'
��� Is prevented from documenting "intranasal" fo rintramuscular inactivated influenza vaccine


Comments

This step covers data quality checking as an informative aspect of vaccine administration


Pre Condition

Order is placed for intramuscular inactivated influenza vaccine.


Post Condition

The intramuscular, inactivated influenza vaccination route has failed to be recorded as intranasal in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.


Evaluation Criteria

The EMR prevents the user for entering 'Intranasal' as a route for the the intramuscular ,inactivated influenza vaccine.


Notes for Testers

No Note


2.2.6. Record Influenza Vaccine administration

The provider documents in the EMR all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the the inactivated influenza vaccine
��� Documents all required information for each vaccine


Comments

No Comments


Pre Condition

Order is placed for inactivated influenza vaccine.


Post Condition

The inactivated influenza vaccinations is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

The tester Verifies that there is a choice for VFC stock as she is VFC Eligible.

EMR Records the following vaccine administration information:

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source (Administration Notes)

New immunization record (NIP001 00)

Value/Text for Vaccine Type

Influenza, seasonal, injectable, preservative free (CVX 140, NDC 66521-0118-02)

Date/Time of Start of Administration

Current Date

Vaccine Administered

Influenza, seasonal, injectable, preservative free (CVX 140, NDC 66521-0118-02)

Administered Amount (of Vaccine)

0.5

Administered Units (of Measure)

mL

Administering Provider

Sandra Molina

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Lot Number

8L4B3521

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

Novartis (NOV)

Completion Status

CP

Route of Administration

IM (NCIT C28161)

Administration Site

Left Deltoid (HL7 LD)

VFC Eligibility

Yes

Funding Source

Public

















Administered Units (of Measure)



















Notes for Testers

No Note


2.3. Juana Mariana Vazquez Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Vazquez.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.



Comments
The Report must include all newly administered vaccines in any order. The report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

Pre Condition
The vaccines for the visit have been administered.

Post Condition
The IIS has received the vaccine information (Z22 message).

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

2.3.1. Transmit the immunization report to the Immunization Registry

The EMR send the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.


Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 203 Value-Test Case Fixed
PID-13[1].7 Local Number 5551212 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type
PID-13[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20120701 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 203 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551212 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type
NK1-5[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK1 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK24
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130831
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 107 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2341
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS3255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS249
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151120 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D643QS8243 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151201 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text Sanofi Pasteur Inc Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9245
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4566
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5534
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2431
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4344
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D335PV9644
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130422
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental decision Presence-Content Indifferent
RXA-18.3 Name of Coding System NIP002 Value-Test Case Fixed
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3281
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2164
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58532
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130418
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9334IN9333
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9553IN2243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150430
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 140 Value-Test Case Fixed
RXA-5.2 Text Influenza, seasonal, injectable, preservative Free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3423 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151230 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier NOV Value-Test Case Fixed
RXA-17.2 Text Novartis Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 66521-0118-02 Value-Test Case Fixed
RXA-5.2 Text Fluvirin Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3521 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier NOV Value-Test Case Fixed
RXA-17.2 Text Novartis Value-Test Case Fixed
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130104
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT48
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0853CC
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0854FF
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160413
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text historical Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0934GG
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 2341BB
RXA-16 Substance Expiration Date
RXA-16.1 Time 20141201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 3452DD Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171201 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Value-Test Case Fixed
RXA-17.2 Text Merck Sharp \T\ Dohme Corp Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier RT Value-Test Case Fixed
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Value-Test Case Fixed
RXR-1.2 Text Subcutaneous Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier RD Value-Test Case Fixed
RXR-2.2 Text Right Deltoid Value-Test Case Fixed
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1 Value-Test Case Fixed
OBX-3.2 Text Reaction Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12 Indifferent
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 21 Value-Test Case Fixed
OBX-5.2 Text varicella Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement published Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20080313 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Mariana Vazquez
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 11/01/2011 11:05
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Local Number (203)555-1212
Email jmg@gmail.com
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator No
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212
Phone Number

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/01/2011
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 12/20/2011
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK1
Substance Expiration Date 12/31/2011
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 05/20/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 11/20/2015
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 12/01/2015
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2011
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 11/21/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2013
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 04/22/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status Refused
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/11/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2013
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 05/10/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2012
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/29/2012
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2013
Administered Amount .25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2014
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 11/04/2014
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2015
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, seasonal, injectable, preservative Free
Date/Time Start of Administration 10/15/2015
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from other provider
Administering Provider J Martinez
Substance Lot Number 8L4B3423
Substance Expiration Date 12/30/2015
Substance Manufacturer Name Novartis
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine Fluvirin
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 10/31/2017
Substance Manufacturer Name Novartis
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/04/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 08/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Sandra Molina
Substance Lot Number 0853CC
Substance Expiration Date 12/15/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 11/22/2015
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 0854FF
Substance Expiration Date 04/13/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 10/15/2016
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider Sandra Molina
Substance Lot Number 0934GG
Substance Expiration Date 12/15/2017
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine varicella virus vaccine
Date/Time Start of Administration 12/15/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 2341BB
Substance Expiration Date 12/01/2014
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine varicella
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 3452DD
Substance Expiration Date 12/01/2017
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public
vaccine type varicella
Date vaccine information statement published 03/13/2008
Date vaccine information statement presented 07/15/2015

2.3.2. Receive ACK Z23 from Immunization Registry

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20160224073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


2.3.3. Record an adverse reaction

The Provider records in the EMR an adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose.

Test Story

Description

Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours.


Comments

No Comments


Pre Condition

The vaccinations for the visit have been administered.


Post Condition

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.


Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Verify that vendor can record the adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission


Notes for Testers

No Note


2.3.4. Transmit the updated vaccination report with adverse reaction to the registry

The EMR generates a Z22 Send Unsolicited Immunization Update Using a VXU correctly and without omission according to supplied test data.

Test Story

Description

The adverse reaction to the MMR of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message.


Comments

No Comments


Pre Condition

An adverse reaction to the MMR of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.


Post Condition

The adverse reaction has been transmitted to the IIS.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 203 Value-Test Case Fixed
PID-13[1].7 Local Number 5551212 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type
PID-13[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20120701 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 203 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551212 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET
NK1-5[2].3 Telecommunication Equipment Type
NK1-5[2].4 Email Address jmg@gmail.com
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK1 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK24
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130831
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 107 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2341
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS3255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS249
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151120 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D643QS8243 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151201 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text Sanofi Pasteur Inc Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9245
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4566
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5534
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2431
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4344
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D335PV9644
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130422
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental decision Presence-Content Indifferent
RXA-18.3 Name of Coding System NIP002 Value-Test Case Fixed
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3281
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2164
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58532
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130418
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9334IN9333
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9553IN2243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150430
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 140 Value-Test Case Fixed
RXA-5.2 Text Influenza, seasonal, injectable, preservative Free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3423 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151230 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier NOV Value-Test Case Fixed
RXA-17.2 Text Novartis Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 66521-0118-02 Value-Test Case Fixed
RXA-5.2 Text Fluvirin Value-Test Case Fixed
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3521 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier NOV Value-Test Case Fixed
RXA-17.2 Text Novartis Value-Test Case Fixed
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130104
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT48
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0853CC
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0854FF
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160413
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text historical Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 0934GG
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 2341BB
RXA-16 Substance Expiration Date
RXA-16.1 Time 20141201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 3452DD Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171201 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Value-Test Case Fixed
RXA-17.2 Text Merck Sharp \T\ Dohme Corp Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier RT Value-Test Case Fixed
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Value-Test Case Fixed
RXR-1.2 Text Subcutaneous Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier RD Value-Test Case Fixed
RXR-2.2 Text Right Deltoid Value-Test Case Fixed
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1 Value-Test Case Fixed
OBX-3.2 Text Reaction Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12 Indifferent
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 21 Value-Test Case Fixed
OBX-5.2 Text varicella Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement published Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20080313 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1 Value-Test Case Fixed
OBX-3.2 Text Reaction Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC9 Value-Test Case Fixed
OBX-5.2 Text persistent, inconsolable crying lasting > 3 hours within 48 hours of dose Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Mariana Vazquez
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 11/01/2011 11:05
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Local Number (203)555-1212
Email jmg@gmail.com
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator No
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212
Phone Number

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/01/2011
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 12/20/2011
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK1
Substance Expiration Date 12/31/2011
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 05/20/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 11/20/2015
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 12/01/2015
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2011
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 11/21/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2013
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 04/22/2013
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status Refused
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/11/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2013
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 05/10/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2012
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/29/2012
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2013
Administered Amount .25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2014
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 11/04/2014
Administered Amount 0.25
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2015
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, seasonal, injectable, preservative Free
Date/Time Start of Administration 10/15/2015
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from other provider
Administering Provider J Martinez
Substance Lot Number 8L4B3423
Substance Expiration Date 12/30/2015
Substance Manufacturer Name Novartis
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine Fluvirin
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 10/31/2017
Substance Manufacturer Name Novartis
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/04/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 08/22/2012
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Sandra Molina
Substance Lot Number 0853CC
Substance Expiration Date 12/15/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 11/22/2015
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 0854FF
Substance Expiration Date 04/13/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 10/15/2016
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider Sandra Molina
Substance Lot Number 0934GG
Substance Expiration Date 12/15/2017
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine varicella virus vaccine
Date/Time Start of Administration 12/15/2013
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 2341BB
Substance Expiration Date 12/01/2014
Substance Manufacturer Name Merck Sharp and Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine varicella
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 3452DD
Substance Expiration Date 12/01/2017
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public
Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose
vaccine type varicella
Date vaccine information statement published 03/13/2008
Date vaccine information statement presented 07/15/2015

2.3.5. Receive ACK Z23 from Immunization Registry for Updated Transmission

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20160224073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


2.4. Juana Mariana Gonzales Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

Pre Condition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

Post Condition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

2.4.1. Produce an immunization report for Juana Mariana Gonzales including all history

The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.


Post Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.


Evaluation Criteria
The following patient demographics are displayed
Patient Identifier Number: Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name: Juana Mariana Vazquez
Date/Time of Birth: 11/01/12011 11:05am
Sex: Female
Patient Address: 4345 Standish Way, Stamford, CT, 06903
Multiple Birth: N
Birth Order: NA
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 11/01/2011
Additional Observations: None
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shoreline Drive,
Stamford Connecticut 06901
Lot#: 6332FK33
Exp Date: 12/14/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 12/20/2011
Additional Observations: None
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Frank Smith
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive,
Stamford Connecticut 06901
Lot#: 6352FK1
Exp Date: 12/31/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 05/20/2012
Additional Observations: None
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6352FK24
Exp Date: 8/31/2013
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 1/22/2012
Additional Observations: None
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2341
Exp Date: 11/30/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)
Date Administered: 3/23/2012
Additional Observations: 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
Dose #:
Doses n Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2433
Exp Date: 9/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/22/2012
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS3255
Exp Date: 12/1/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 2/21/2013
Additional Observations:
Dose #: 4
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS249
Exp Date: 3/1/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 11/20/2015
Additional Observations:
Dose #: 5
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .05 mL
Administering Provider: Linda Casera
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D643QS8243
Exp Date: 12/01/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M54K9245
Exp Date: 3/24/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 3/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M55K3342
Exp Date: 10/30/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/22/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M75K4566
Exp Date: 5/23/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 11/21/2012
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M53K5534
Exp Date: 2/22/2013
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV2431
Exp Date: 10/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 3/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV4344
Exp Date: 3/23/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 2/21/2013
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D335PV9644
Exp Date: 4/22/2014
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/22/2011
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P243V3281
Exp Date: 1/30/2011
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 3/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P343V8321
Exp Date: 3/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/22/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V2164
Exp Date: 8/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/11/2013
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V58532
Exp Date: 4/18/2013
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV533
Exp Date: 2/15/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 3/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV932
Exp Date: 5/10/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/25/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/292012
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/2/2013
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9334IN9333
Exp Date: 5/22/2014
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 11/4/2014
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9553IN2243
Exp Date: 4/30/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, seasonal, injectable, preservative Free (CVX 140)
Fluvirin (NDC 66521-0118-02)
Date Administered: 10/15/2015
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Frank Smith
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .5 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 8L4B3423|
Exp Date: 12/30/2015
Manufacturer: Novartis (MVX NOV)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation
Administered: Influenza, seasonal, injectable, preservative Free (CVX 140)
Fluvirin (66521-0118-02)
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Frank Smith
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .5 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 8L4B3521
Exp Date: 7/15/2017
Manufacturer: Novartis (MVX NOV)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site:Left Deltoid (HL7 LD)

Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 11/23/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT33
Exp Date: 1/4/2013
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)

Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/23/2013
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT48
Exp Date: 9/11/2013
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)

Vaccine Group: MMR
Administered: measles, mumps, rubella virus vaccine (CVX 03)
MMR II (NDC 0006-4681-00)"
Date Administered: 08/22/2012
Additional Observations:
Dose #:
Doses in Series: 2
Valid Dose: N
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 0853CC
Exp Date: 12/15/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)

Vaccine Group: MMR
Administered: measles, mumps, rubella virus vaccine (CVX 03)
MMR II (0006-4681-00)"
Date Administered: 11/22/2015
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 0854FF
Exp Date: 4/13/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: MMR
Administered: measles, mumps, rubella virus vaccine (CVX 03)
MMR II (NDC 0006-4681-00)"
Date Administered: 14 days PRIOR to day of TEST
Additional Observations: Reaction (LOINC 31044-1)/fever of >40.5C (105F) within 48 hours of dose (CDCPHINVS XC12)
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 0934GG
Exp Date: 10/15/2017
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: Varicella
Administered: Varicella vaccine (CVX 21)
VarivaxI (NDC 0006-4827-00)"
Date Administered: 12/15/2013
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Martinez
Entered By: Carlos Herrera
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 2341BB
Exp Date: 12/1/2014
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)

Vaccine Group: IPV
Due Date: 10/31/2015
Earliest Date to Give: 10/31/2015
Overdue Date: 10/31/2017
Immunization Schedule: ACIP

Vaccine Group: influenza, unspecified formulation
Due Date: 10/21/2016
Earliest Date to Give: 9/1/2016
Immunization Schedule: ACIP

Vaccine Group: varicella
Due Date: 10/31/2015
Earliest Date to Give: 10/31/2015
Overdue Date: 10/31/2017
Immunization Schedule: ACIP


Notes for Testers

No Note


3. Juan Marcel Marina Visit

Juan Marcel Marina visits the provider where his immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

3.1. Query the Registry for Juan Marcel Gonzales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juan Marcel Gonzales.

Test Story

Description

The EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juan Marcel Marina. Querying the registry will consist of the vendor creating Z44 messages for Juan Marcel Marina to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.

Comments
No Comments

Pre Condition
Juan Marcel Marina is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load'

Post Condition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned .

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

3.1.1. Select Patient Juan Marcel Marina

Select patient Juan Marcel Marina, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juan Marcel Marina is selected as the patient and his record is opened in the EMR.


Comments

No Comments


Pre Condition

Juan Marcel Marina Initial Data Load completed.


Post Condition

Juan Marcel Marina is the active working patient in the EMR.


Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Tester shall verify that the product can distinguish Juan Marcel Gonzales from similar sounding names using all of the pediatric demographics:

  • Patient ID (previously listed as "Medicaid Number") - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juan
  • Patient Name: Middle - Marcel
  • Patient Name: Last - Marina
  • Patient Date of Birth - 03/04/2015
  • Birth Time - 11:00
  • Patient Gender (Administrative Sex) - M
  • Patient Multiple Birth Indicator - No
  • Patient Birth Order - NA
  • Responsible Person Name: First - Manuel
  • Responsible Person Name: Middle - Marcel
  • Responsible Person Name: Last - Marina
  • Responsible Person Name: Relationship to Patient - Father
  • Mother's Name: First - Anita
  • Mother's Name: Middle - Francesca
  • Mother's Name: Last - Marina
  • Mother's Name: Maiden Last - Morales
  • Patient Address: Street - 4623 Standish Way
  • Patient Address: City - Stamford
  • Patient Address: State - CT
  • Patient Address: Country - US
  • Patient Address: Zipcode - 06903
  • Patient Address: County of Residence - Fairfield
  • Race - White
  • Ethnicity - Hispanic or Latino
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shoreline Drive, Stamford Connecticut 06901
  • Patient Birth State - CT
  • Patient Primary Language - English
  • Patient Telephone Number - (203) 555-1213
  • Patient Telephone Number Type (e.g., home, cell) - home
  • Patient E-mail Address -
  • Publicity Code- Reminder/recall - no calls (03 HL70215)
  • Protection Indicator
  • Protection Indicator Effective Date
  • Immunization Registry Status
  • Preferred Contact Method - Text

Notes for Testers

No Note


3.1.2. Query Registry for vaccination history and forecast for Juan Marcel Marina

The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre Condition

Juan Marcel Marina Initial Data Load is completed.

Juan Marcel Marina is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juan Marcel Marina.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juan Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20140304 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551213 Value-Test Case Fixed
QPD-10 Multiple birth indicator N Value-Test Case Fixed
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juan Marcel Gonzales
Mother's Maiden Name Morales
ID Number 123456
Date/Time of Birth 03/04/2014
Sex Male
Patient Address 4623 Standish Way Stamford CT 06903
Patient Phone (203)555-1213
Birth Indicator No
Birth Order

3.1.3. View and import response to request for vaccination history for Juan Marcel Marina

The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR

Test Story

Description

The physician accesses the record for Juan Marcel Marina and:

��� Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded

��� Views the registry history including the second dose of Hepatitis B vaccine given late (at 2 years of age) and no history of a third dose; influenza vaccine was also not given since 2015


Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Marina)


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 3/3/2015
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 4/15/2015
Verify that the EMR is alerted that this dose was given too late
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/15/2015
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 7/13/2015
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 9/16/2015
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 9/20/2016
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/14/2015
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 7/21/2015
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 9/27/2015
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/4/2016
poliovirus vaccine, inactivated (CVX 10) administered 5/14/2015
poliovirus vaccine, inactivated (CVX 10) administered 7/21/2015
poliovirus vaccine, inactivated (CVX 10) administered 10/15/2015
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/18/2015
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 7/21/2015
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 9/27/2015
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/4/2016
rotavirus, live, monovalent vaccine (CVX 119) administered 5/18/2015
rotavirus, live, monovalent vaccine (CVX 119) administered 7/21/2015
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/27/2015
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/20/2016
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/15/2016
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 12/1/2013
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 10/20/2016

Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20161015001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juan Marcel Gonzales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2011
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2011
Date/Time Administration-End 11/01/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2011
Date/Time Administration-End 12/20/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2012
Date/Time Administration-End 05/20/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2013
Date/Time Administration-End 02/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2012
Date/Time Administration-End 11/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2013
Date/Time Administration-End 01/11/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2012
Date/Time Administration-End 09/25/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/29/2012
Date/Time Administration-End 10/29/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2013
Date/Time Administration-End 10/02/2013
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 11/04/2014
Date/Time Administration-End 11/04/2014
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2012
Date/Time Administration-End 11/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2013
Date/Time Administration-End 05/23/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2012
Date/Time Administration-End 08/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2015
Date/Time Administration-End 11/22/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2013
Date/Time Administration-End 12/15/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2012
Earliest Date to Give 04/29/2012
Latest Date to Give
Date When Vaccine Overdue 04/30/2013
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2016
Earliest Date to Give 09/01/2016
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason

3.1.4. View the vaccination forecast for Juan Marcel Marina returned by the Immunization Registry

The EMR displays the current Immunization Forecast to the user for Juan Marcel Marina as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Juan Marcel Marina and:

��� Views the vaccine forecast provided by the Immunization Registry


Comments

No Comments


Pre Condition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing


Post Condition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.


Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.


Evaluation Criteria

The EMR displays the information returned from the Immunization Registry according to the Juror Document.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20161015001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121029
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141104
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151122
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juan Marcel Gonzales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2011
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2011
Date/Time Administration-End 11/01/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2011
Date/Time Administration-End 12/20/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2012
Date/Time Administration-End 05/20/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2013
Date/Time Administration-End 02/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2012
Date/Time Administration-End 11/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2012
Date/Time Administration-End 05/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2013
Date/Time Administration-End 01/11/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2012
Date/Time Administration-End 03/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2012
Date/Time Administration-End 09/25/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/29/2012
Date/Time Administration-End 10/29/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2013
Date/Time Administration-End 10/02/2013
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 11/04/2014
Date/Time Administration-End 11/04/2014
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2012
Date/Time Administration-End 11/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2013
Date/Time Administration-End 05/23/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2012
Date/Time Administration-End 08/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2015
Date/Time Administration-End 11/22/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2013
Date/Time Administration-End 12/15/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2012
Earliest Date to Give 04/29/2012
Latest Date to Give
Date When Vaccine Overdue 04/30/2013
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2016
Earliest Date to Give 09/01/2016
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2015
Earliest Date to Give 10/31/2015
Latest Date to Give
Date When Vaccine Overdue 10/31/2017
Status in Immunization Series
Forecast Reason

3.1.5. View the vaccination forecast for Juan Marcel Marina

The EMR displays the current Immunization Forecast to the user for Juan Marcel Marina either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juan Marcel Marina and, once the vaccine history is reconciled in the EMR, the vaccine forecast is updated :

��� The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)


Comments

The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EMR defined means.


Pre Condition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales)


Post Condition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.


Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 5/21/2015
DTaP due on 11/22/2016
IPV due on 11/22/2016
MMR due on 11/22/2016
Varicella due on 11/22/2016
influenza, unspecified formulation due on Oct 22, 2016 or later

Notes for Testers

No Note


3.2. Juan Marcel Marina, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.

Comments
No Comments

Pre Condition
Juan Marcel Marina is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load'

Post Condition
Visit orders are entered in Juan Marcel Marina's record.

Test Objectives

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

3.2.1. Order meningococcal vaccine for or congenital asplenia indication

Due to the congenital asplenia indication, the EMR recommends Menveo vaccine.

Test Story

Description

The physician accesses the record for Juan Marcel Marina. Due to the existing condition of congenital asplenia, the EMR recommends meningococcal vaccine.

The recommendations up to 24 months of age are: Menveo (for catch up since this patient has had no prior vaccine 2 doses, 12 weeks apart and after 1st birthday), MenHibRix (for catch up 2 doses 8 weeks apart), and Menactra (after 24 months - 2 doses 8 weeks apart, at least 4 weeks after complete PCV13 series).

The physician orders the administration of Menveo (IM - CVX 198, NDC 46028-0208-1)


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.


Post Condition

User notified of history of indication for meningococcal vaccine due to the congenital asplenia condition.
The order for the meningococcal vaccine is placed.
.


Test Objectives

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type Meningococcal vaccine - Menveo (CVX 198, NDC 46028-0208-01) Manufacturer SKB
Date/Time Vaccine Refusal was recorded Current Date
Alert Notification the patient has congenital asplenia, an indication for meningococcal vaccine.


Notes for Testers

No Note


3.2.2. Orders administration of Hepatitis B vaccine

The provider orders a Hepatitis B vaccine (dose 3).

Test Story

Description

As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered.


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast reviewed.


Post Condition

Hepatitis B vaccine is ordered for the patient.


Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Order Value/Text for Vaccine Type hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-11)
Date/Time Vaccine was recorded Current Date

Notes for Testers

No Note


3.2.3. Orders administration of DTaP vaccine and alerted that the dose is too early

The provider orders a DTaP vaccine (dose 5). The EMR provides an alert that the vaccine dose is too early.

Test Story

Description

The fifth DTaP is ordered, and the provider is notified that the dose is too early.


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast is available in the EMR.


Post Condition

DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early.


Test Objectives

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Date/Time Vaccine order was recorded Current Date
Alert Notification that the dose is too early

Notes for Testers

No Note


3.2.4. Attempt to record HepB Vaccine administration route with data validation checking

The provider records the vaccine administration route in the EMR and is prevented from incorrectly documenting vaccine route

Test Story

Description

The nurse documents administration route for the HepB vaccine
��� Is prevented from documenting "oral" for HepB vaccine


Comments

This step covers data quality checking as an informative aspect of vaccine administration


Pre Condition

Order is placed for HepB vaccine.


Post Condition

The HepB vaccination route has failed to be recorded as 'oral' in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.


Evaluation Criteria

The EMR prevents the user for entering 'Oral' as a route for the the HepB vaccine.


Notes for Testers

No Note


3.2.5. Records Hepatitis B Vaccine lot number with expired lot alert

The provider records the vaccine administration lot number in the EMR and is alerted of the expired lot.

Test Story

Description

The nurse documents administration lot number for the Hepatitis B vaccine
��� Is prevented from ordering the Hepatitis B lot as it has expired
��� Documents administration from a different lot that is not expired


Comments
No Comments

Pre Condition

Order is placed for Hepatitis B vaccine.


Post Condition

The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EMR.


Test Objectives

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Date/Time of Start of Administration Current Date
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)
Lot Number (Expired) 6332FK18
Substance Expiration Date (Expired) 6/15/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB)
Alert Alerts user to expired lot

Notes for Testers

No Note


3.2.6. Record Hepatitis B Vaccine administration

The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the the Hepatitis B vaccine
• Documents all required information for the vaccine


Comments

No Comments


Pre Condition

Order is placed for Hepatitis B vaccine.


Post Condition

The Hepatitis B vaccination is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source

New immunization record (NIP001 00)

Date/Time of Start of Administration

Current Date

Vaccine Administered

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)

Administered Amount (of Vaccine)

0.5

Administered Units (of Measure)

mL

Administration Notes

Administering Provider

Sandra Molina

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Lot Number

6332FK26

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

GlaxoSmithKline Biologicals SA (MVX SKB)

Completion Status

CP

Route of Administration

Intramuscular (NCIT C28161, HL70162: IM)

Administration Site

Left Deltoid (HL70162 LD)

VFC Eligibility

No

Funding Source

Private





































Notes for Testers

No Note


3.2.7. Records Influenza Vaccine administration with VFC eligibility checking

The provider records the vaccine administration from a VFC source and alerted that the patient is not VFC eligible.

Test Story

Description

The nurse documents administration for the inactivated influenza vaccine from a VFC source
��� Is alerted that the patient is not eligible for VFC
��� Orders a different non-VFC lot of inactivated influenza vaccine


Comments

No Comments


Pre Condition

Order is placed for inactivated influenza vaccine.


Post Condition

The user is notified of vaccine dose ineligibility.


Test Objectives

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.


Evaluation Criteria

The provider documents a VFC lot to be administered in the EMR. Once notified that the patient is not eligible for the VFC, then a non-VFC lot is selected.

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source

New immunization record (NIP001 00)

Value/Text for Vaccine Type

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Date/Time of Start of Administration

Current Date

Vaccine Administered

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

VFC lot (not administered)

D8043IN8422

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

Sanofi Pasteur (MVX PMC)

Alert

Patient is not VFC Eligible

Funding Source

Private

The Provider selects a non-VFC Lot:

Vaccine Lot # (administered):

D8043IN8855

Vaccine Expiration Date:

8/25/2015

Notes for Testers

No Note


3.2.8. Record Influenza Vaccine administration for Juan Marcel Marina

The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the inactivated influenza vaccine
��� Documents all required information for each vaccine


Comments

No Comments


Pre Condition

Order is placed for inactivated influenza vaccine.


Post Condition

The inactivated influenza vaccine administration is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source (Administration Notes)

New immunization record (NIP001 00)

Value/Text for Vaccine Type

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Date/Time of Start of Administration

Current Date

Vaccine Administered

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Administered Amount (of Vaccine)

0.25

Administered Units (of Measure)

mL

Administering Provider

Sandra Molina

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Lot Number

D8043IN8855

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

Sanofi Pasteur (MVX PMC)

Completion Status

CP

Route of Administration

Intramuscular (NCIT C28161, HL70162: IM)

Administration Site

Left Thigh (HL7 LT)

VFC Eligibility

No

Funding Source

Private


















Notes for Testers

No Note


3.2.9. Record Meningococcal Vaccine administration for Juan Marcel Marina

The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the meningococcal vaccine
��� Documents all required information for each vaccine


Comments

No Comments


Pre Condition

Order is placed for meningococcal vaccine.


Post Condition

The meningococcal vaccine administration is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source (Administration Notes)

New immunization record (NIP001 00)

Value/Text for Vaccine Type

Meningococcal vaccine - Menveo (CVX 136, NDC 46028-0208-01)

Date/Time of Start of Administration

Current Date

Vaccine Administered

Meningococcal vaccine - Menveo (CVX 136, NDC 46028-0208-01)

Administered Amount (of Vaccine)

0.5

Administered Units (of Measure)

mL

Administering Provider

Sandra Molina

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Lot Number

6333FK87

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

GlaxoSmithKline Biologicals SA (MVX SKB)

Completion Status

CP

Route of Administration

Intramuscular (NCIT C28161, HL70162: IM)

Administration Site

Left Thigh (HL7 LT)

VFC Eligibility

No

Funding Source

Private





































Notes for Testers

No Note


3.3. Juan Marcel Marina Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juan Marcel Marina.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.


Comments
No Comments

Pre Condition
The vaccines for the visit have been administered.

Post Condition
The IIS has received the vaccine information (Z22 message).

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

3.3.1. Transmit the Immunization Report for Juan Marcel Marina

The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EMR imported from the IIS.


Comments

The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS.


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina
PID-5.2 Given Name Juan Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales
PID-6.7 Name Type Code M
PID-7 Date/Time of Birth
PID-7.1 Time 201503041100 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551213 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20150304 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150304 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales
NK1-2.2 Given Name Manuel Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4623 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551213 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Presence-Content Indifferent
ORC-10.3 Given Name Lisa Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Presence-Content Indifferent
ORC-12.3 Given Name Jane Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150304 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150415 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK2
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151001
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0820-11 Value-Test Case Fixed
RXA-5.2 Text ENGERIX-B Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK26 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150515 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150713 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2434
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150916 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS250
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20160820 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS250
RXA-16 Substance Expiration Date
RXA-16.1 Time 20170301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150514 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20141030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150927 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4577
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20160504 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5535
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161014
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150514 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2444
RXA-16 Substance Expiration Date
RXA-16.1 Time 2015100304
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150518 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8445
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150927
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2175
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20160504 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58544
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160118
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150518 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text Rotavirus Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV543
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151029
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150921 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text Rotavirus Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV933
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150927 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8738
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151020 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 161 Value-Test Case Fixed
RXA-5.2 Text Influenza Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8798
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0514-25 Value-Test Case Fixed
RXA-5.2 Text FLUZONE QUADRIVALENT Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.25 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8855 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text Sanofi Pasteur Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20160515 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text Hepatitis A Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT35
RXA-16 Substance Expiration Date
RXA-16.1 Time 20170104
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20160921 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text Hepatitis A Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT47 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161111 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161020 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 94 Value-Test Case Fixed
RXA-5.2 Text MMR and Varicella Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W27V7632
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 46028-0208-01 Value-Test Case Fixed
RXA-5.2 Text Menveo Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6333FK87 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161031 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161020
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text MMR and Varicella
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W27V7632
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Thigh Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC elig Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 08 Presence-Content Indifferent
OBX-5.2 Text Hepatitis B
OBX-5.3 Name of Coding System CVX Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement published Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC elig Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hepatitis B
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20160331
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20160715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20160715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20160715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juan Marcel Marina
Mother's Maiden Name Anita Morales
ID Number 123456 987633
Date/Time of Birth 03/04/2015 11:00
Administrative Sex Male
Patient Address 4623 Standish Way Stamford CT 06903 USA
Local Number (203)555-1213
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 03/04/2015
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 03/04/2015
Protection Indicator No
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Manuel Marcel Gonzales
Relationship Father
Address 4623 Standish Way Stamford CT 06903
Phone Number (203)555-1213

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 03/04/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6332FK34
Substance Expiration Date 12/14/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 04/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6352FK2
Substance Expiration Date 10/01/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine ENGERIX-B
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6332FK26
Substance Expiration Date 10/31/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Private
vaccine type Hepatitis B
Date vaccine information statement published 07/15/2015
Date vaccine information statement presented 07/15/2015

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 05/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2342
Substance Expiration Date 11/30/2016
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 07/13/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2434
Substance Expiration Date 09/04/2015
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 09/16/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS250
Substance Expiration Date 12/01/2015
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 08/20/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS250
Substance Expiration Date 03/01/2017
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 05/14/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M54K9255
Substance Expiration Date 03/24/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 07/21/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M55K3343
Substance Expiration Date 10/30/2014
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 09/27/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M75K4577
Substance Expiration Date 05/23/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 05/04/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M53K5535
Substance Expiration Date 10/14/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 05/14/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV2444
Substance Expiration Date 10/03/2015
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 07/21/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV4343
Substance Expiration Date 03/23/2016
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 10/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV4343
Substance Expiration Date 02/22/2016
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 05/18/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P243V3321
Substance Expiration Date 01/30/2016
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 07/21/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P343V8445
Substance Expiration Date 03/30/2016
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 09/27/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V2175
Substance Expiration Date 08/30/2016
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 05/04/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V58544
Substance Expiration Date 01/18/2016
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Rotavirus
Date/Time Start of Administration 05/18/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV543
Substance Expiration Date 10/29/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Rotavirus
Date/Time Start of Administration 09/21/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV933
Substance Expiration Date 05/10/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Thigh Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Influenza
Date/Time Start of Administration 09/27/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8738
Substance Expiration Date 03/12/2016
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Influenza
Date/Time Start of Administration 10/20/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8798
Substance Expiration Date 05/22/2016
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine FLUZONE QUADRIVALENT
Date/Time Start of Administration 10/31/2016
Administered Amount 0.25
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number D8043IN8855
Substance Expiration Date 10/31/2017
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Private

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis A
Date/Time Start of Administration 05/15/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RT35
Substance Expiration Date 01/04/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis A
Date/Time Start of Administration 09/21/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6359RT47
Substance Expiration Date 11/11/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine MMR and Varicella
Date/Time Start of Administration 10/20/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7W27V7632
Substance Expiration Date 12/15/2017
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Menveo
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6333FK87
Substance Expiration Date 10/31/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type Hepatitis B
VIS Publication Date 03/31/2016
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Private

Vaccine Administration Information
Element Data
Administered Vaccine MMR and Varicella
Date/Time Start of Administration 10/20/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7W27V7632
Substance Expiration Date 12/15/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

3.3.2. Receive ACK Z23 from Immunization Registry

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20160224073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


3.3.3. Transmit Delete from Bad Lot

The Provider receives notification that the Hepatitis B vaccine lot 6352FK2 has been identified as a bad lot. A delete notification for the Hepatitis B vaccination administered is transmitted to the Immunization Registry.

Test Story

Description

Following the vaccine administration of Hepatitis B, the provider receives notification that the Hepatitis B vaccine lot 6352FK2 has been identified as a bad lot. A delete notification for the Hepatitis B vaccination administered is transmitted to the Immunization Registry for Juan Marcel Marina.


Comments

No Comments


Pre Condition

The vaccinations for the visit have been administered.
The vaccination report (Z22) has been transmitted to the IIS, including the record of the Hepatitis B vaccination with lot 6352FK2.


Post Condition

The EMR has recorded that the hepatitis B vaccination was from a bad lot. Juan Marcel Marina's record is updated to reflect that the immunization given with lot 6352FK2 is invalid. The Delete notification for this vaccination has been transmitted to the Immunization Registry.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Support for delete functionality.


Evaluation Criteria

Verify that EMR can record the bad lot. Verify that the vaccination record for Juan Marcel Marina for the Hepatitis B vaccination given with lot 6352FK2 is marked as invalid.
Verify that a valid Delete notification is transmitted to the Immunization Registry for this vaccination: The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.2 Given Name Juan Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201403041100 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-30 Patient Death Indicator

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151031
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hepatitis B
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text Date vaccine information statement published
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text Date vaccine information statement presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juan Marcel Marina Transmit Immunization Report
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juan Marcel Gonzales
Date of Birth 03/04/2014
Sex Male
Address 1
Street 4623 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Anita Francesca Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Pediatrics
Vaccine Group Hepatitis B
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/31/2015
Date/Time Administration-End 10/31/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


3.3.4. Receive ACK Z23 from Immunization Registry

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20160224073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


3.4. Juan Marcel Marina Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

Pre Condition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

Post Condition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

3.4.1. Produce an immunization report for Juan Marcel Marina including all history

The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.


Post Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.


Evaluation Criteria
The following patient demographics are displayed:
Patient Identifier Number: Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name: Juan Marcel Marina
Date/Time of Birth: 3/4/2015 11:00am
Sex: Male
Patient Address: 4623 Standish Way, Stamford, CT 06903
Multiple Birth: N
Birth Order: NA

The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 3/4/2015
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive,
Stamford Connecticut 06901
Lot#: 6332FK34
Exp Date: 12/14/2015
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)

Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 4/15/2015
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6352FK2
Exp Date: 10/1/2016
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)

Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: Current Date
Additional Observations:
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 6332FK26
Exp Date: 10/31/2017
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL70162 LD)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/15/2015
Additional Observations:
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2342
Exp Date: 11/30/2016
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 7/13/2015
Additional Observations:
Dose #: 2
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2434
Exp Date: 9/4/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 916/2015
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 12/1/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 9/20/2016
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 3/1/2017
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/14/2015
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M54K9255
Exp Date: 3/24/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 7/21/2015
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M55K3343
Exp Date: 10/30/2015
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 9/27/2015
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M75K4577
Exp Date: 5/23/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/4/2016
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M53K5535
Exp Date: 10/14/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 5/14/2015
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV2444
Exp Date: 10/4/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 7/21/2015
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV4343
Exp Date: 3/23/2016
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 10/15/2015
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D335PV9654
Exp Date: 2/22/2016
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/18/2015
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P243V3321
Exp Date: 1/30/2016
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 7/21/2015
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P343V8445
Exp Date: 3/30/2016
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 9/27/2015
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V2175
Exp Date: 8/30/2016
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/4/2016
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V58544
Exp Date: 10/18/2016
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 5/18/2015
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV533
Exp Date: 10/29/2015
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 7/21/2015
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV932
Exp Date: 5/10/2016
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/27/2015
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8734
Exp Date: 3/12/2016
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/20/2016
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8798
Exp Date: 5/22/2017
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: D8043IN8855
Exp Date:10/31/2017
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/15/2016
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT35
Exp Date: 1/4/2017
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: Current Date
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT47
Exp Date: 10/31/2017
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 10/20/2016
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7W27V7632
Exp Date: 12/15/2017
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)
The Following Vaccine Forecast is displayed:

Vaccine Group: HepB
Due Date: 11/22/2016
Earliest Date to Give: 08/30/2014
Overdue Date: 08/31/2016
Immunization Schedule: ACIP
Vaccine Group: Dtap
Due Date: 3/3/2019
Earliest Date to Give: 3/3/2019
Latest Date to Give: 3/3/2020
Overdue Date: 3/4/2021
Immunization Schedule: ACIP
Vaccine Group: IPV
Due Date: 3/3/2019
Earliest Date to Give: 3/3/2019
Overdue Date: 3/4/2021
Immunization Schedule: ACIP
Vaccine Group: Influenza
Due Date: 9/1/2017
Earliest Date to Give: 9/1/2017
Overdue Date: 2/1/2018
Immunization Schedule: ACIP
Vaccine Group: HepA
Due Date: 11/22/2016
Earliest Date to Give: 8/30/2016
Immunization Schedule: ACIPVaccine Group: MMR
Due Date: 3/2/2019
Earliest Date to Give: 3/2/2019
Overdue Date: 3/2/2021
Immunization Schedule: ACIP
Vaccine Group: Varicella
Due Date: 3/2/2019
Earliest Date to Give: 3/2/2019
Overdue Date: 3/2/2021
Immunization Schedule: ACIP

Notes for Testers

No Note


4. Juana Mariela Gonzales Morales Visit

Infant twin, Juana Mariela Gonzales Morales visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

4.1. Query the Registry for Juana Mariela Gonzales Morales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariela Gonzales Morales.

Test Story

Description

The EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariela Gonzales Morales. Querying the registry will consist of the vendor creating Z44 messages for Juana Mariela Gonzales Morales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.

Comments
No Comments

Pre Condition
Juana Mariela Gonzales Morales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Juana Mariela Gonzales Morales Initial Data Load'

Post Condition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

4.1.1. Select Patient Juana Mariela Gonzales Morales

Select patient Juana Mariela Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Juana Mariela Gonzales Morales is selected as the patient and her record is opened in the EMR.


Comments

No Comments


Pre Condition

Juana Mariela Gonzales Morales Initial Data Load completed.


Post Condition

Juana Mariela Gonzales Morales is the active working patient in the EMR.


Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria
Tester shall verify that the product can distinguish Juana Mariela Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

  • Patient ID (previously listed as "Medicaid Number") - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana
  • Patient Name: Middle - Mariela
  • Patient Name: Last - Gonzales
  • Patient Date of Birth - 10/01/2016
  • Birth Time - 11:00
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - Yes
  • Patient Birth Order - 1
  • Responsible Person Name: First - Joanna
  • Responsible Person Name: Middle - Elena
  • Responsible Person Name: Last - Gonzales
  • Responsible Person Name: Relationship to Patient - Mother
  • Mother's Name: First - Joanna
  • Mother's Name: Middle - Elena
  • Mother's Name: Last - Gonzales
  • Mother's Name: Maiden Last - Morales
  • Patient Address: Street - 3321 Standish Way
  • Patient Address: City - Stamford
  • Patient Address: State - CT
  • Patient Address: Country - US
  • Patient Address: Zipcode - 06903
  • Patient Address: County of Residence - Fairfield
  • Race - White
  • Ethnicity - Hispanic or Latino
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903
  • Patient Birth State - CT
  • Patient Primary Language - English
  • Patient Telephone Number - (203) 555-1214
  • Patient Telephone Number Type (e.g., home, cell) - home
  • Patient E-mail Address -
  • Publicity Code- Reminder/recall - no calls (03 HL70215)
  • Protection Indicator - No
  • Protection Indicator Effective Date
  • Immunization Registry Status
  • Preferred Contact Method - Text

Notes for Testers

Patient last name from the hospital returned by the IIS is Morales (the mother's maiden name). The patient last name in the EMR should be Gonzales. This test verifies that the EMR can match the returned record despite the different last name.


4.1.2. Query Registry for vaccination history and forecast for Juana Mariela Gonzales Morales

The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre Condition

Juana Mariela Gonzales Morales Initial Data Load is completed.

Juana Mariela Gonzales Morales is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariela Gonzales Morales.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mariela Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201610011100 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551214 Value-Test Case Fixed
QPD-10 Multiple birth indicator Indifferent
QPD-11 Birth order Indifferent

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juana Mariela Gonzales
Mother's Maiden Name Morales
ID Number
Date/Time of Birth 10/01/2016 11:00
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903
Patient Phone (203)555-1214
Birth Indicator No
Birth Order

4.1.3. View and import response to request for vaccination history for Juana Mariela Gonzales Morales

The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales Morales and:

��� Accepts the single vaccine in the registry record into the EHR history


Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariela Gonzales Morales)


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/1/2016


Notes for Testers

If the EMR is unable to match and import the previous immunization record, they will need to add the following historical immunization manually:

Vaccine from Practice HepB

Entered BY

Susan Pike

Y

Ordering Provider

Justin Parker

Y

Entering Organization

Shoreline Hospital

Y

Administration Notes (Vaccine Event information source)

New immunization record (NIP001 00)

Y

Date/Time of Start of Administration

10/01/2016

Y

Vaccine Administered

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-01)

Y

Administered Amount (of Vaccine)

0.5

Y

Administered Units (of Measure)

mL

Y

Administering Provider

Susan Pike

Y

Administered-at Location

15 Atlantic Avenue, Stamford, CT, 06903

Y

Lot Number

6332FK34

Y

Substance Expiration Date

12/14/2016

Y

Substance Manufacturer Name

GlaxoSmithKline Biologicals SA (MVX SKB)

Y

Completion Status

CP

Y

Route of Administration

IM

Y

Administration Site

Left Thigh

Y


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariela
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201610011100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariela
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201610011100
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20181002
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariela Gonzales Morales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariela Morales
Date of Birth 10/01/2016
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2016
Date/Time Administration-End 10/01/2016
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2016
Earliest Date to Give 10/31/2016
Latest Date to Give
Date When Vaccine Overdue 12/01/2016
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2017
Earliest Date to Give 09/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason

4.1.4. View the vaccination forecast for Juana Mariela Gonzales Morales returned by the Immunization Registry

The EMR displays the current Immunization Forecast to the user for Juana Mariela Gonzales Morales as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales Morales and:

��� Views the vaccine forecast provided by the Immunization Registry


Comments

No Comments


Pre Condition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing


Post Condition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.


Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.


Evaluation Criteria

The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that this includes:

Hep B Peds NOS due on 10/21/2016
DTaP due on 11/30/2016
Hib due on 11/30/2016

IPV due on 11/30/2016

Pneumococcal conjugate due on 11/30/2016
Rotavirus due on 11/30/2016
HepA due on 10/1/2017
MMR due on 10/1/2017

Varicella due on 10/19/2017

influenza, unspecified formulation due on 9/1/2017 or later


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariela
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201610011100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariela
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201610011100
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20181002
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariela Gonzales Morales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariela Morales
Date of Birth 10/01/2016
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2016
Date/Time Administration-End 10/01/2016
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2016
Earliest Date to Give 10/31/2016
Latest Date to Give
Date When Vaccine Overdue 12/01/2016
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2017
Earliest Date to Give 09/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason

4.1.5. View the vaccination forecast for Juana Mariela Gonzales Morales

The EMR displays the current Immunization Forecast to the user for Juana Mariela Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales Morales and:

��� Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)


Comments

No Comments


Pre Condition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Mariela Gonzales Morales)


Post Condition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.


Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 10/21/2016
DTaP due on 11/30/2016
Hib due on 11/30/2016
IPV due on 11/30/2016
Pneumococcal conjugate due on 11/30/2016
Rotavirus due on 11/30/2016
HepA due on 10/1/2017
MMR due on 10/1/2017
Varicella due on 10/1/2017

influenza, unspecified formulation due on Nov 26, 2015 or later


Notes for Testers

No Note


4.2. Juana Mariela Gonzales Morales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.

Comments
No Comments

Pre Condition
Juana Mariela Gonzales Morales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariela Gonzales Morales Initial Data Load'

Post Condition
Visit orders are entered in Juana Mariela Gonzales Morales' record.

Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule)

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

4.2.1. Enter Initial Clinical Information for Juana Mariela

The EHR captures structured data indicating that Juana Mariela has a fever in the current visit.

Test Story

Description

The triage nurse enters basic information on Juana Mariela Gonzales Morales - she has a fever (Temperature of 100.8o F).


Comments

No Comments


Pre Condition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariela Gonzales Morales.


Post Condition

The clinical record for Juana Mariela Gonzales Morales indicates that she currently has a fever (temperature 100.8oF)..


Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule):

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical data provided with all required attributes indicated by [Y]:

Vital Signs Fever of 100.1 (@code LOINC 8310-5 @value 100.1)
Vital Signs Observation Date Date of current visit
Problems (If vendor uses problems for alert computations, then this should be included.) Problem list: ( Low grade pyrexia (finding) 304213008)
Problem Observation Date Date of current visit

Notes for Testers

No Note


4.2.2. Enters a deferral for the vaccines due

Enters a deferral for vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales Morales and:
��� Enters a deferral for the vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month


Comments

No Comment


Pre Condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EMR indicating 5 vaccines are due: Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus


Post Condition

Vaccine deferral is recorded indicating the medical reason of low grade fever


Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
pneumococcal conjugate vaccine, 13 valent (CVX 133)
rotavirus, live, monovalent vaccine (CVX 119)
Date/Time Vaccine not administered was recorded Current Date
Alert contraindication of fever
Substance/Treatment Deferral Start Date:Vaccination contraindication/precaution effective date (30946-8 LOINC) Current Date
Substance/Treatment Deferral End Date/Vaccination temporary contraindication/precaution expiration date (30944-3 LOINC) : Current Date +30 Days
Substance/Treatment Deferral Contraindication: Vaccination contraindication/precaution (30945-0 LOINC): current fever with moderate-to-severe illness (PHVS_VaccinationContraindication_IIS - VXC23)
Completion Status: NA
Date/Time Vaccine Deferral was recorded: Current Date

Notes for Testers

No Note


4.3. Juana Mariela Gonzales Morales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariela Gonzales Morales.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.


Comments
No Comments

Pre Condition
The vaccines for the visit have been administered.

Post Condition
The IIS has received the vaccine information (Z22 message).

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

4.3.1. Transmit the Immunization Report for Juana Mariela Gonzales Morales

The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes the vaccine deferral and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EMR imported from the IIS.


Comments

The Report must include all vaccine deferrals recorded in the EMR in any order. The report may include the information imported from the IIS


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EMR. Current Date is expected for the Non-Administration date and deferral date.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariela Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201610011100 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551212 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 1 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20161001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20161001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis
ORC-10.3 Given Name Lisa
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FL432
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text DTaP, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 152
RXA-5.2 Text Pneumococcal Conjugate, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031
RXA-5 Administered Code
RXA-5.1 Identifier 122
RXA-5.2 Text rotavirus, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20170101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20170101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20170101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20170101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20170101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161201
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Mariela Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2016 11:00
Administrative Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Local Number (203)555-1212
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2016
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 10/01/2016
Protection Indicator No
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Susan Pike
Substance Lot Number 6332FL432
Substance Expiration Date 12/14/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 12/01/2016
Vaccination temporary contraindication/precaution expiration date 01/01/2017

Vaccine Administration Information
Element Data
Administered Vaccine DTaP, unspecified formulation
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 12/01/2016
Vaccination temporary contraindication/precaution expiration date 01/01/2017

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 12/01/2016
Vaccination temporary contraindication/precaution expiration date 01/01/2017

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 12/01/2016
Vaccination temporary contraindication/precaution expiration date 01/01/2017

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, unspecified formulation
Date/Time Start of Administration 10/31/2016
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 12/01/2016
Vaccination temporary contraindication/precaution expiration date 01/01/2017

4.3.2. Receive ACK Z23 from Immunization Registry

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
No Test Objectives

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20160224073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


4.4. Juana Mariela Gonzales Morales Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

Pre Condition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

Post Condition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

4.4.1. Produce an immunization report for Juana Mariela Gonzales Morales including all history

The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.


Post Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.

Evaluation Criteria
The following patient demographics are displayed:
Patient Identifier Number: Vendor Supplied
Patient Identifier Type Code: Vendor Supplied
Patient Name: Juana Mariela Gonzales Morales
Date/Time of Birth: 10/1/2016 11:00am
Sex: Female
Patient Address: 3321 Standish Way, Stamford, CT 06903
Multiple Birth: Y
Birth Order: 1
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 10/1/2016
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shoreline Drive,
Stamford Connecticut 06901
Lot#: 6332FL432
Exp Date: 12/14/2016
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
The Following Vaccine Forecast is displayed:
Vaccine Group: Hep B Peds NOS
Due Date: 10/21/2016
Earliest Date to Give: 10/21/2016
Overdue Date: 12/1/2016
Immunization Schedule: ACIP
Vaccine Group: DTaP
Due Date: 11/30/2016
Earliest Date to Give: 11/30/2016
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Hib
Due Date: 11/30/2016
Earliest Date to Give: 11/30/2016
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: IPV
Due Date: 11/30/2016
Earliest Date to Give:11/30/2016
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Pneumococcal conjugate
Due Date: 11/30/2016
Earliest Date to Give: 11/30/2016
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Rotavirus
Due Date: 11/30/2016
Earliest Date to Give: 11/30/2016
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: Influenza
Due Date: 9/1/2017 or later
later
Earliest Date to Give: 9/1/2017
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
Vaccine Group: HepA
Due Date: 10/1/2017
Earliest Date to Give: 10/1/2017
Overdue Date: 10/2/2018
Immunization Schedule: ACIP
Vaccine Group: MMR
Due Date: 10/1/2017
Earliest Date to Give: 10/1/2017
Overdue Date: 12/31/2017
Immunization Schedule: ACIP
Vaccine Group: Varicella
Due Date: 10/1/2017
Earliest Date to Give: 10/1/2017
Overdue Date: 12/31/2017
Immunization Schedule: ACIP

Notes for Testers

No Note


5. Juana Maria Gonzales Morales Visit

Infant twin, Juana Maria Gonzales Morales visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

5.1. Query the Registry for Juana Maria Gonzales Morales.

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales Morales

Test Story

Description

The EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales Morales. Querying the registry will consist of the vendor creating Z44 messages for Juana Maria Gonzales Morales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.


Comments
No Comments

Pre Condition
Mariela Gonzales Morales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Mariela Gonzales Morales Initial Data Load'

Post Condition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

5.1.1. Select Patient Juana Maria Gonzales Morales

Select patient Juana Maria Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Juana Maria Gonzales Morales is selected as the patient and her record is opened in the EMR.


Comments

No Comments


Pre Condition

Juana Maria Gonzales Morales Initial Data Load completed.


Post Condition

Juana Maria Gonzales Morales is the active working patient in the EMR.


Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother's maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Maria Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

  • Patient ID (previously listed as "Medicaid Number") - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana
  • Patient Name: Middle - Maria Gonzales
  • Patient Name: Last - Morales
  • Patient Date of Birth - 10/01/2015
  • Birth Time - 11:15
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - Yes
  • Patient Birth Order - 2
  • Responsible Person Name: First - Joanna
  • Responsible Person Name: Middle - Gonzales
  • Responsible Person Name: Last - Morales
  • Responsible Person Name: Relationship to Patient - Mother
  • Mother's Name: First - Joanna
  • Mother's Name: Middle - Gonzales
  • Mother's Name: Last - Morales
  • Mother's Name: Maiden Last - Gonzales
  • Patient Address: Street - 3321 Standish Way
  • Patient Address: City - Stamford
  • Patient Address: State - CT
  • Patient Address: Country - US
  • Patient Address: Zipcode - 06903
  • Patient Address: County of Residence - Fairfield
  • Race - White
  • Ethnicity - Hispanic or Latino
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903
  • Patient Birth State - CT
  • Patient Primary Language - English
  • Patient Telephone Number - (203) 555-1214
  • Patient Telephone Number Type (e.g., home, cell) - home
  • Patient E-mail Address -
  • Publicity Code- Reminder/recall - no calls (03 HL70215)
  • Protection Indicator
  • Protection Indicator Effective Date
  • Immunization Registry Status
  • Preferred Contact Method - Text

Notes for Testers

No Note


5.1.2. Query Registry for vaccination history and forecast too many matches found response

Vendor SHALL be able to Generate a Z44 Query correctly and without ommission according to supplied test data

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that too many matches are found.


Comments

While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step.


Pre Condition

Juana Maria Gonzales Morales Initial Data Load is completed.

Juana Maria Gonzales Morales is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales Morales.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Setup step to test error handling: Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20151001 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales Morales
Mother's Maiden Name Gonzales
ID Number 123456
Date/Time of Birth 10/01/2015
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.3. Error Handling - Too many matches found

The EMR receives a response from the registry query that too many persons are found. The EMR notifies the user/clinician.

Test Story

Description

The EMR processes notifies the user that there were too many matches found in response to the query the Immunization Registry for an Evaluated History and Forecast.


Comments

The sending (querying) system will need to accept a response indicating that too many matches were found.


Pre Condition
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

Post Condition

The Immunization Registry responds with a message is indicating too many matches are found. The EMR has notified the user.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Tests error handling: Test the capability of the EHR-S to process a response message that returns too many matches found and to provide an indication to the end user.


Evaluation Criteria
The tester verifies that the user/clinician is notified of no match.

The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.

Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-3.2_Response_NF_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-IZ-1
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-22.6.3 Universal ID Type ISO
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-IZ-1
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-23.6.3 Universal ID Type ISO
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201610011115
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Maria Gonzales Morales.
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


5.1.4. Query Registry for vaccination history and forecast no persons found response

Vendor SHALL be able to Generate a Z44 Query correctly and without ommission according to supplied test data

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that no persons are found.


Comments

While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step.


Pre Condition

Juana Maria Gonzales Morales Initial Data Load is completed.

Juana Maria Gonzales Morales is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales Morales.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Tests error handling: Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20151001 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales Morales
Mother's Maiden Name Gonzales
ID Number 123456
Date/Time of Birth 10/01/2015
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.5. Error Handling - No persons found

The EMR receives a response from the registry query that no persons are found. The EMR notifies the user/clinician.

Test Story

Description

The EMR processes notifies the user that there were no persons found in response to the query the Immunization Registry for an Evaluated History and Forecast.


Comments

The sending (querying) system will need to accept a response indicating that no matches were found.


Pre Condition
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

Post Condition

The Immunization Registry responds with a message is indicating no person record is found. The EMR has notified the user.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Tests error handling: Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria
The tester verifies that the user/clinician is notified of no match.

The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.

Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-3.2_Response_NF_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-IZ-1
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-22.6.3 Universal ID Type ISO
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-IZ-1
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-23.6.3 Universal ID Type ISO
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201610011115
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Maria Gonzales Morales.
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


5.1.6. Query Registry for vaccination history and forecast for Juana Maria Gonzales Morales

Vendor SHALL be able to Generate a Z44 Query correctly and without ommission according to supplied test data

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre Condition

Juana Maria Gonzales Morales Initial Data Load is completed.

Juana Maria Gonzales Morales is the active working patient in the EMR.


Post Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales Morales.


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20151001 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales Morales
Mother's Maiden Name Gonzales
ID Number 123456
Date/Time of Birth 10/01/2015
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.7. View and import response to request for vaccination history for Juana Maria Gonzales Morales

The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

��� Accepts the single vaccine in the registry record into the EHR history


Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.


Post Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales Morales)


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry "on demand" (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 3/30/2015


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Morales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20161001
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y
QPD-11 Birth order 2

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.2 Given Name BG2
PID-5.3 Second and Further Given Names or Initials Thereof
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201610011115
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20181002
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Maria Gonzales Morales.
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name BG2 Morales
Date of Birth 10/01/2016
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2016
Date/Time Administration-End 10/01/2016
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2016
Earliest Date to Give 10/31/2016
Latest Date to Give
Date When Vaccine Overdue 12/01/2016
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2017
Earliest Date to Give 09/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason

5.1.8. View the vaccination forecast for Juana Maria Gonzales Morales returned by the Immunization Registry

The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

��� Views the vaccine forecast provided by the Immunization Registry


Comments

No Comments


Pre Condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. The response containing the vaccine forecast is returned from the IIS, and is available in the EMR.


Post Condition

A vaccine forecast based upon the complete vaccine history as returned from the IIS is available to the user.


Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.


Notes for Testers

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Morales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20161001
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y
QPD-11 Birth order 2

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.2 Given Name BG2
PID-5.3 Second and Further Given Names or Initials Thereof
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201610011115
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161201
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20161130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20181002
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Maria Gonzales Morales.
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name BG2 Morales
Date of Birth 10/01/2016
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2016
Date/Time Administration-End 10/01/2016
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2016
Earliest Date to Give 10/31/2016
Latest Date to Give
Date When Vaccine Overdue 12/01/2016
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2016
Earliest Date to Give 11/30/2016
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2017
Earliest Date to Give 09/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 10/02/2018
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2017
Earliest Date to Give 10/01/2017
Latest Date to Give
Date When Vaccine Overdue 01/01/2018
Status in Immunization Series
Forecast Reason

5.1.9. View the vaccination forecast for Juana Maria Gonzales Morales

The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

��� Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)


Comments

No Comments


Pre Condition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales Morales)


Post Condition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.


Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015
Hib due on 7/29/2015
IPV due on 7/29/2015
Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015
HepA due on 5/29/2016
MMR due on 5/29/2016
Varicella due on 5/29/2016
influenza, unspecified formulation due on Nov 26, 2015 or later

Notes for Testers

No Note


5.2. Juana Maria Gonzales Morales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.

Comments
No Comments

Pre Condition
Juana Maria Gonzales Morales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Maria Gonzales Morales Initial Data Load'

Post Condition
Visit orders are entered in Juana Maria Gonzales Morales' record.

Test Objectives

Supporting data for error handling tests.

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

5.2.1. Record Combo Vaccine administration

The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the the DTaP-hepatitis B and poliovirus vaccine
��� Documents all required information for the vaccine


Comments

No Comments


Pre Condition

Order is placed for DTaP-hepatitis B and poliovirus vaccine.


Post Condition

The DTaP-hepatitis B and poliovirus vaccination is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY

Sandra Molina

Ordering Provider

Frank Smith

Entering Organization

Shoreline Pediatrics

Vaccine Event information source

New immunization record (NIP001 00)

Date/Time of Start of Administration

Current Date

Vaccine Administered

DTaP-hepatitis B and poliovirus vaccine (CVX 110)
Pediarix (NDC 58160-0811-52)

Administered Amount (of Vaccine)

0.5

Administered Units (of Measure)

mL

Administration Notes

Administering Provider

Sandra Molina

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Lot Number

6559FK32

Substance Expiration Date

10/31/2017

Substance Manufacturer Name

GlaxoSmithKline Biologicals SA (MVX SKB)

Completion Status

CP

Route of Administration

Intramuscular (NCIT C28161, HL70162: IM)

Administration Site

Left Deltoid (HL70162 LD)

VFC Eligibility

No

Funding Source

Private



Notes for Testers

No Note


5.3. Juana Maria Gonzales Morales Transmit Immunization Report - Error Handling

This Test Case verifies the ability of the EMR to handle errors and warnings in response to the Send the Immunization Report to the Immunization Registry (VXU/Z22) transaction for Juana Maria Gonzales Morales.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EMR imported from the IIS.

This transaction will result in an error or warning from the IIS.

Comments
No Comments

Pre Condition
The vaccines for the visit have been administered.

Post Condition
The IIS has received the vaccine information (Z22 message) and issued a Z23 response with an error or warning.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Verify that the EMR is able to receive and display the error or warning response from the IIS.

Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers
No Note

5.3.1. Transmit the Immunization Report for Juana Maria Gonzales Morales - fatal error handling

The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in a fatal error from the IIS to assess the EMR ability to receive and display the error.

Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. T The report MAY send the immunizations that the EMR imported from the IIS. This will result in a warning from the IIS to assess the EMR ability to receive and display the error.


Comments

The Report must include all vaccine deferrals recorded in the EMR in any order. The report may include the information imported from the IIS


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Setup to verify that the EMR is able to receive and display the error response from the IIS.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EMR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales
PID-6.7 Name Type Code M
PID-7 Date/Time of Birth
PID-7.1 Time 201610011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20161001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20161001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Value-Test Case Fixed
RXA-10.3 Given Name Susan Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FL432
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161214 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-52 Value-Test Case Fixed
RXA-5.2 Text Pediarix Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2016 11:15
Administrative Sex Female
Patient Address 1 3321 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2016
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 10/01/2016
Protection Indicator Yes
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Susan Pike
Substance Lot Number 6332FL432
Substance Expiration Date 12/14/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine Pediarix
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 10/31/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Element Data
VIS Publication Date 10/31/2016
VIS Presentation Date 10/31/2016
vaccine fund pgm elig cat VFC eligible
Vaccine funding source Private

5.3.2. Receive ACK Z23 Fatal Error - CVX Code

The Immunization Registry returns a fatal error message indicating a table mapping error for the CVX code submitted was found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a fatal error message indicating a table mapping error for the CVX code submitted was found during the course of filing the message.


Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Error Handling Support for a fatal error returned by the IIS, and the ability of the EMR to display a notification of this error to the user.

Evaluation Criteria
The acknowledgement error message is consumed by the system responsible for the content of the administration message.
The error returned is visible in the EMR .

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625121047.853-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-7.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-IZ-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-IZ-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-7.1_Send_V04_Z22

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 5
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity E
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Vaccine code not recognized - message rejected

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


5.3.3. Transmit the Immunization Report for Juana Maria Gonzales Morales - warning handling

The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in a warning from the IIS to assess the EMR ability to receive and display the warning.

Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EMR ability to receive and display the error.


Comments

The Report must include the newly administered vaccine recorded in the EMR. The report may include the information imported from the IIS


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Set up to verify that the EMR is able to receive and display the multiple warning response from the IIS.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EMR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales
PID-6.7 Name Type Code M
PID-7 Date/Time of Birth
PID-7.1 Time 201610011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20161001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20161001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Value-Test Case Fixed
RXA-10.3 Given Name Susan Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FL432
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161214 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-52 Value-Test Case Fixed
RXA-5.2 Text Pediarix Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2016 11:15
Administrative Sex Female
Patient Address 1 3321 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2016
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 10/01/2016
Protection Indicator Yes
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Susan Pike
Substance Lot Number 6332FL432
Substance Expiration Date 12/14/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine Pediarix
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 10/31/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Element Data
VIS Publication Date 10/31/2016
VIS Presentation Date 10/31/2016
vaccine fund pgm elig cat VFC eligible
Vaccine funding source Private

5.3.4. Receive ACK Z23 Warning - Invalid Value

The Immunization Registry returns a warning message indicating an invalid administration site code submitted was found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a warning message indicating an unrecognized administration site code submitted was found during the course of filing the message.


Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Error Handling Support for a warning returned by the IIS, and the ability of the EMR to display a notification of this warning to the user.

Evaluation Criteria
The acknowledgement warning message is consumed by the system responsible for the content of the administration message.
The warning returned is visible in the EMR .

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625103328.758-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-8.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-IZ-1
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-22.6.3 Universal ID Type ISO
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-IZ-1
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-23.6.3 Universal ID Type ISO
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 1
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


5.3.5. Transmit the Immunization Report for Juana Maria Gonzales Morales - Multiple warning handling

The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in multiple warnings from the IIS to assess the EMR ability to receive and display the warnings.

Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EMR ability to receive and display the warnings.


Comments

The Report must include the newly administered vaccine recorded in the EMR. The report may include the information imported from the IIS


Pre Condition

The vaccines for the visit have been administered.


Post Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Set up to verify that the EMR is able to receive and display the multiple warning response from the IIS.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes for Testers

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EMR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales
PID-6.7 Name Type Code M
PID-7 Date/Time of Birth
PID-7.1 Time 201610011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20161001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20161001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.3 Given Name Lisa Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Value-Test Case Fixed
ORC-12.3 Given Name Jane Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Value-Test Case Fixed
RXA-10.3 Given Name Susan Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FL432
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161214 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20161031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-52 Value-Test Case Fixed
RXA-5.2 Text Pediarix Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171031 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text IM Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20161031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20161031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

TestData Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2016 11:15
Administrative Sex Female
Patient Address 1 3321 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2016
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 10/01/2016
Protection Indicator Yes
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2016
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Susan Pike
Substance Lot Number 6332FL432
Substance Expiration Date 12/14/2016
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine Pediarix
Date/Time Start of Administration 10/31/2016
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 10/31/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Element Data
VIS Publication Date 10/31/2016
VIS Presentation Date 10/31/2016
vaccine fund pgm elig cat VFC eligible
Vaccine funding source Private

5.3.6. Receive ACK Z23 Multiple Warnings

The Immunization Registry returns a message with multiple warnings for invalid administration site codes submitted found during the course of filing the message.

Test Story

Description
The Immunization Registry returns a message with multiple warnings indicating unrecognized administration site codes submitted were found during the course of filing the message.


Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
The ACK Z23 is received by the EHR.

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Error Handling Support for multiple warnings returned by the IIS, and the ability of the EMR to display a notification of these warnings to the user.

Evaluation Criteria
The acknowledgement warning message is consumed by the system responsible for the content of the administration message.
The multiple warnings returned is visible in the EMR .

Notes for Testers
Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625115038.044-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-9.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-9.1_Send_V04_Z22

ERR[*]
ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 2
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 2
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

TestData Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


6. Cohort Report

This test will consist of generating a cohort report to list all patients who are due or overdue for immunizations showing all overdue immunizations with the associated due/overdue dates.

6.1. Due and Overdue Immunizations

List all patients who are due or overdue for immunizations showing all overdue immunizations.

Test Story

Description

The provider periodically uses the EMR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.


Comments

No Comments


Pre Condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.


Post Condition

The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EMR.


Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.


Evaluation Criteria
Evaluation criteria is defined within each test step.

Notes for Testers

No Note


6.1.1. Produce Overdue Immunizations Cohort Report

The provider uses the EMR to create a report for all patient vaccinations overdue with the contact information.

Test Story

Description
The provider periodically uses the EMR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.

Comments

No Comments


Pre Condition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.

Post Condition

The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EMR.


Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.


Evaluation Criteria

The following patient information is provided on the cohort report:

Patient Name

Juana Mariana Vazquez

Preferred Contact Method

Phone

Contact information using preferred contact (email, text, phone, mailing address)

(203) 555-1212

Patient Identifier Number

Vendor Supplied

Patient Identifier Type Code

Vendor Supplied

Date/Time of Birth

11/1/2011 11:05am

Sex

Female

Vaccine Group

IPV

Due Date

10/31/2015

Overdue Date

10/31/2017

Dose #

4

Dose in Series

4

Link to full record

Vendor Supplied

Patient Name

Juana Mariela Gonzales Morales

Preferred Contact Method

Text

Contact information using preferred contact (email, text, phone, mailing address)

(203) 555-1214

Patient Identifier Number

Vendor Supplied

Patient Identifier Type Code

Vendor Supplied

Date/Time of Birth

10/1/2016 11am

Sex

Female

Vaccine Group

Hep B Peds NOS

Due Date

10/31/2016

Overdue Date

12/1/2016

Dose #

2

Dose in Series

3

Vaccine Group

DTaP

Due Date

11/30/2016

Dose #

1

Dose in Series

5

Vaccine Group

Hib

Due Date

11/30/2016

Dose #

1

Dose in Series

4

Vaccine Group

IPV

Due Date

11/30/2016

Dose #

1

Dose in Series

4

Vaccine Group

Pneumococcal conjugate

Due Date

11/30/2016

Dose #

1

Dose in Series

4

Dose #

2

Dose in Series

3

Link to full record

Vendor Supplied


Patient Name

Juana Maria Gonzales Morales

Preferred Contact Method

Text

Contact information using preferred contact (email, text, phone, mailing address)

(203) 555-1214

Patient Identifier Number

Vendor Supplied

Patient Identifier Type Code

Vendor Supplied

Date/Time of Birth

5/30/2015 11:15am

Sex

Female

Vaccine Group

Hib

Due Date

11/30/2016

Dose #

1

Dose in Series

4

Vaccine Group

Pneumococcal conjugate

Due Date

11/30/2016

Dose #

1

Dose in Series

4

Dose #

2

Dose in Series

3

Link to full record

Vendor Supplied


























































Notes for Testers

No Note